International consensus definitions of video signs of concussion in professional sports

Abstract

BackgroundThe use of video to assist professional sporting bodies with the diagnosis of sport-related concussion (SRC) has been well established; however, there has been little consistency across sporting codes with regards to which video signs should be used, and the definitions of each of these signs.AimThe aims of this study were to develop a consensus for the video signs considered to be most useful in the identification of a possible SRC and to develop a consensus definition for each of these video signs across the sporting codes.MethodsA brief questionnaire was used to assess which video signs were considered to be most useful in the identification of a possible concussion. Consensus was defined as >90% agreement by respondents. Existing definitions of these video signs from individual sports were collated, and individual components of the definitions were assessed and ranked. A modified Delphi approach was then used to create a consensus definition for each of the video signs.ResultsRespondents representing seven sporting bodies (Australian Football League, Cricket Australia, Major League Baseball, NFL, NHL, National Rugby League, World Rugby) reached consensus on eight video signs of concussion. Thirteen representatives from the seven professional sports ranked the definition components. Consolidation and refinement of the video signs and their definitions resulted in consensus definitions for six video signs of possible concussion: lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action—floppy and blank/vacant look.ConclusionsThese video signs and definitions have reached international consensus, are indicated for use by professional sporting bodies and will form the basis for further collaborative research.

Video Analysis of Concussion Exposures in a National Collegiate Athletic Association Division I Football Team

“…Player cues are the player's actions immediately after the collision that caused the concussion. We applied the consensus statement by Davis et al 12 as our basis for these player cues, which included lying motionless, motor incoordination, slowness to get up, and tonic posturing. An additional category, hand to helmet, was added, as we found this to be the most common action after a concussion.…”

“…32 With the advent of in-game video analysis, investigators are able to characterize SRCs in greater detail. 11,12,27,29 These details include player cues, helmet impacts, and field position at the time of the concussion. 8,27,38 A greater knowledge of the details of in-game SRCs can better prepare the sideline medical staff to identify concussions in real time.…”

Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high‐level football

“…Observe and recognize (phase 0): Team physicians should observe the match (or training) with a focus on potential head injury, which often happens during aerial duels, 5,31,32 and specifically the immediate red and orange flags ( Figure 3), such as (suspected) loss of consciousness, convulsion or abnormal posturing, slowness, or imbalance. 10,33 The injury mechanism and player behavior are best recognized using direct observation, if possible supported by immediate video review. 22,33 With respect to concussion, observable signs demonstrated on video, such as lying motionless, motor incoordination, ataxia, staggering gait, no protective action (floppy, tonic), cervical hypotonia, seizure/convulsion, tonic posturing, and blank/vacant look, have been shown to be useful for clinical decision making.…”

Video Analysis and Verification of Direct Head Impacts Recorded by Wearable Sensors in Junior Rugby League Players

“…Recently, various technology has been introduced to assist in the identi cation of head impacts and suspected concussions during athlete competitions. For instance, sideline video review [9,10], and to a lesser extent, impact sensors in helmeted and non-helmeted sports have been introduced to measure kinematic forces to the head [11].…”

“…Recently, multiple experts from seven national and international professional sporting codes developed international consensus de nitions of video signs of possible concussion, agreeing on six video signs: (i) lying motionless (for > 2 seconds); (ii) motor incoordination (e.g., losing balance); (iii) impact seizure; (iv) tonic posturing (involuntary sustained contraction of one or more limbs); (v) no protective action/ oppy; and (vi) blank/vacant look [9]. The National Rugby League (NRL) has incorporated a Head Injury Assessment (HIA) process that uses sideline video review as a method to identify direct head impacts and potential signs of concussion in players.…”